A Case Manager II (CM II) comprehensively plans for case management of a targeted patient population on a designated unit(s). Works with the physicians and multidisciplinary care team to facilitate efficient quality care and achievement of desired treatment outcomes. Holds joint accountability with social worker for discharge planning and continuity of care. Assures that admission and continued stay are medically necessary and communicates clinical information to payers to ensure reimbursement.

JOB RESPONSIBILITIES

PEOPLE

Identifies leadership opportunities for professional growth of peers.

Communicates in an active, positive and effective manner to all health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner, listens and responds to the ideas of others.

Implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. May include preceptorship.

Uses downtime efficiently, aware of team members’ workload, consistently offers assistance, and responds positively to requests for assistance from other team members.

FINANCE

Contributes to meeting departmental financial target on scorecard, with focus on length of stay.

Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state and federal agencies. Responds to requests for information, monitors covered days, and initiates review to assure that all days are covered and reimbursable.

Manages all patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.

QUALITY/SAFETY

Modifies care based on continuous evaluation of the patient’s condition, demonstrates clinical problem-solving and critical thinking, and makes decisions using evidence-based analytical approach.

Plans for routine discharge and anticipates/prevents and manages/elevates emergent situations. Specific focus given to discharge plan and elimination of barriers.

Contributes to meeting departmental targets for quality and safety measures on scorecard.

Uses a structured format for regular communication with patients and families.

Serves as a unit-based leader for comprehensive case management activities including assessing all patients and leading team to set discharge plan, participating in daily Care Coordination Rounds, and identifying and leading resolution to barriers of efficient patient throughput.

Uses clinical expertise and high risk screening tools to identify need for case management and/or social work intervention. Screening is accomplished by patient/family interview, review of the medical record including previous episodes of care, H&P, lab and other test results/findings, plan of care, physician orders, nursing and progress notes.

Completes full assessment based on the case management high-risk screening tool.

Continuously reviews the total picture of the patient for opportunities for care facilitation and needs for discharge planning.

Documentation should reflect, completed patient screening/assessment and reassessment upon admission and concurrently as needed. This should be documented in MethOD.

Facilitates discharge planning activities for assigned patients and collaborates with the social worker and other members of the interdisciplinary team, as well as patient and family, on complex discharges. Maintains ownership of the discharge planning process on assigned units.

Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance using InterQual Hospital Severity of Illness and Intensity of Service Criteria or Milliman Care Guidelines. Standard for initial review is within 24 hours of entry or next working day. Standard for concurrent clinical reviews is every 48 hours and no more than 72 hours.

Supports patients and families in preventing/resolving clinical or ethical issues.

Contributes to meeting target for patient satisfaction on scorecard, with focus on discharge domain.

Uses knowledge of levels of care to ensure discharge disposition is to the appropriate level and facilitates transfers. Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults Social Worker to assess psychosocial needs associated with transition to alternative levels of care.

Uses therapeutic communication to establish a relationship with patients and families and communicates the discharge plan.

GROWTH/INNOVATION

Provides education to unit-based physicians, nurses, and other healthcare providers on any case management topics.

Identifies and presents areas for improvement in patient care or unit operations and offers solutions by participating in unit projects and activities.

Supportive of change initiatives. Adapts to unexpected changes.

Identifies areas for improvement based on understanding of evidence-based practice literature. Initiates evidence-based practice/performance improvement projects based on these observations.

Identifies own learning needs, consults with healthcare team experts and seeks continuing education opportunities to meet those needs.

This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.

Knowledge of health care financial and payer issues, and eligibility for state, local and federal programs (acquired within 6 months of hire)

Computer skills

Advanced oral and written communication skills

Collaboration, negotiation, and mediation skills

Time management and prioritization skills

Critical thinking

Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

Case Manager (Weekends)
Houston Methodist The Woodlands Hospital, The Woodlands, TX
Work Shift: WEEKENDWork Week: Saturday and Sunday Also on the $380 million hospital campus, located at the intersection of I-45 and TX 242, is a ...